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Long-Term Patient-Reported Outcomes after Multiport Robot-Assisted Surgery versus Video-Assisted Surgery for Lung

Xing Wei¹, Hongfan Yu², Wei Dai¹

¹Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China.

Annals of Surgical Oncology

|February 10, 2026

Abstract

Background:

The purpose of this study was to compare patient-reported outcomes (PROs) and perioperative clinical outcomes during 1 year post surgery between robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS), including multiportal (M-VATS) and uniportal (U-VATS) approaches, in patients with lung cancer.

Methods:

Data from a prospective cohort study (CN-PRO-Lung3) were analyzed, and patients with primary lung cancer who underwent RATS or VATS were included. Primary outcomes were postoperative symptoms and daily functioning assessed using the Perioperative Symptom Assessment (PSA)-Lung, and exploratory outcomes included health-related quality of life (HRQoL) based on the Five-Level EuroQol Five-Dimensional Questionnaire and other clinical outcomes. Propensity score matching (PSM) was adjusted for baseline differences.

Results:

After the PSM of 687 patients, 91 patients were matched between RATS and M-VATS and 119 between RATS and U-VATS. Compared with those undergoing M-VATS, patients undergoing RATS reported lower rates of moderate-to-severe fatigue (P = 0.017) and disturbed sleep (P = 0.049) in the hospital. Additionally, RATS demonstrated better clinical outcomes, including more lymph-node dissections (P < 0.001), less blood loss (P < 0.001), shorter operative time (P < 0.001), and reduced hospital stays (P < 0.001) than M-VATS but incurred higher costs (P < 0.001). Compared with those undergoing U-VATS, patients undergoing RATS reported higher rates of moderate-to-severe cough (P = 0.007) and slower initial HRQoL recovery after discharge.

Conclusions:

Compared with M-VATS, RATS offers perioperative advantages, including reduced symptoms and better clinical outcomes, but at higher costs. Compared with U-VATS, RATS enhanced lymph-node dissection rates but increased postoperative cough and slowed HRQoL recovery. This study highlights the importance of incorporating PROs into surgical decision-making. Clinical registration ChiCTR2000033016 ( https://www.chictr.org.cn/searchprojEN.html ).

Keywords:

Health-related quality of life (HRQoL)Lung cancer Patient-reported outcomes (PROs)Perioperative outcomes Robot-assisted thoracoscopic surgery (RATS)Video-assisted thoracoscopic surgery (VATS)

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